Gastrointestinal Flashcards
Where is McBurney’s point
1/3 from anterior superior iliac spine to umbilicus
What is Rovsing’s sign
Palpation of left abdomen causes pain at McBurney’s point
Can be a sign on inferior appendix
What is psoas sign
Pain on flexion of hip against resistance or passive hyperextension of hip
Can be a sign of retrocecal appendix
What is obturator sign
Flexion then external or internal rotation of right hip hip causes pain
Can be a sign of a pelvic appendix
Investigations for appendicitis
Increased WBC
R/o pregnancy
AXR - free air if peroratoed, loss of psoas shadow
US - rule out gyne causes, may be able to visualise appendix
CT - thick wall, appemdocloth, only done after us considered
Management of appendicitis
IVF
Surgery
Abx - ampicillin, gentamicin and metronidazole
What is the definition of cholecystitis
inflamed gallbladder 2ndary to impacted gallstone
What is the definition of choledocholithiasis
gallstone in common bile duct
What is the definition of cholangitis
Obstructed of common bile duct causing biliary sepsis
What is charcot’s triad
fever, RUQ pain and jaundice
What is Reynold’s pentad
fever, RUQ pain, jaundice, shock, confusion
Investigations for cholecystitis/cholangitis
Increases WCC
Increased bili, ALT, ASST, *ALP
Blood cultures
R/o pancreatitis
Ultasound
Management of cholecystitis/cholangitis
NPO, IVF
NG if ileum
Analgesia
Abx - ampicillin + gentamicin/cipro + met
cholecystitis - surgery
cholangitis - ERCP + sphincterotomy, consider laparotomy
Signs of symptoms of diverticulitis
Fever
LLQ pain
Alternating constipation and diarrhea
Urinary symptoms
Nausea/vomiting
S+S fistula
Fever
Investigations for diverticulitis
Leukocytosis, increased Cr
Urinalysis, CRP
AXR - free air
**CT
Management for diverticulitis
Outpatient/uncomplicated:
Bowel rest/ clear liquid diet x 2-3 days
High fibre diet
Cipro and falgyl or amoxicillin/clav if indicated
Complicated:
NPO, IVF, NG
Cipro and flagyl
Percutaneous drainage if abscess
C scope after 6-8 weeks
When to consider surgery in diverticulitis
Unstable with peritonitis
Abscess >/ 4 cm / fistula / ruptured abscess
Complex
Causes of pancreatitis
Gallstones
Ethanol
Tumours
Scorpion sting
Mmicrobiology - TB, mumps reubella, HIV, CMV
Autoimmune
Surgery/trauma
Hyperlipidemia
Emboli/ischaemia
Drugs (furosemidem estrogen, H2 blockers, valproate, abx, ASA)
Signs and symptoms of pancreatitis
Pain, epigastric, radiates to pain, decreased leaning forward
N and V
Jaundice
Hypotension / tachycardia
Cullens and grey turners sign
Investigations for pancreatitis
High WBC
High amylase
High lipase - preferred test
High ALT
AXR - colon cut off sign
Ultrasound - preferred test
CT
Management of pancreatitis
IVF
NPO, NG
Analgesia
Drain abscess
Surgery if necrotic
What is Ranson’s criteria
Prognosis for pancreatitis
At admission:
Glucose >11
Age >55
LDH >350
AST >250
WBC >16
During 48h:
Ca <2
HCG decreased more than 10%
aPO2 <60
Base >4
Urea increase > 1.8
What gene is celiac related to
HLA-DQ2/DQ8
What are the patterns of celiac disease
Classic: malabsorption symptoms
Non-classic: intestinal and extraintestinal symptoms
Subclinical: no symptoms, diagnosed from screening
Potential: abnormal antibiotics but normal histology
What conditions are associated with celiac disease
T1DM
Autoimmune thyroditis and liver disease
Down syndrome
Turner syndrome
IgA deficienc
What rash is typically seen in celiac
dermatitis herpetiform
What deficiencies are commonly seen in celiac disease
Vitamin B12 deficiency
Iron deficiency
Can have low calcium and vitamin D
What investigations are done to investigate for celiac disease
** Anti-TTG IgA
Must have equivalent of 3 slices of wheat bread a day for 1-3 months prior to testing
Serum IgA - if deficient order Anti-DGP
What monitoring should be done for celiac disease?
Annual anti-TTG
Q2Year TSH
Q1Year if previously normal ALT and AST
What cancer is associated with celiac
High risk T-cell lymphoma
What are the dermatological extraintestinal manifestations of crohn’s
Erythema nodosum
Pyoderma gangrenous
Perianal skin tags
Oral mucosal lesions
Psoriasis
Pallor
What are the rheumatological extraintestinal manifestations of crohn’s
Inflammatory arthropathy
AnkSpon
Sacroilitis
What are the occular extraintestinal manifestations of crohn’s
Uveitis
Episcleritis
What are the hepatobiliary extraintestinal manifestations of crohn’s
Primary sclerosing chalngitis
Fatty liver
What are the urological extraintestinal manifestations of crohn’s
Stones
Fistula
What is the sequelae of malabsoprtion in Crohn’s?
Anemia
Cholelithiasis
Nephrolithiasis
Metabolic bome disease
What are the immune mediated diseases associated with Crohn’s
Asthma
Chronic bronchitis
Pericarditis
Psoriasis
Celiac
RA
MS
What medications are used for an acute flare of Crohn’s
Prednisone
What medications are used in Crohn’s
Thiopuriness
Methotrexate
Biologics
What are the risks of long term PPI use
Hip fracture
C Diff
Pneumonia
Low vitamin b12, mag, iron
Hypoparathyroid
What are the Rome IV criteria
Recurrent abdo pain on ave atleast 1 day a week for the past 3 months with 2 of the following:
Related to defecation
Associated with a change in freq of stool
Assocaited with a change in appearance of stool
What is the treatment for H. Pylori
First line:
Amoxicillin 1000mg BID + Clarithromycin 500mg BID + Metronidazole 500mg BID and PPI for 14 days
If penicillin allergic:
Bismuth + tetracycline + metronidazole + PPI
What is always involved in UC
the rectum
What is the montreal classification of UC
Proctitis - within 18cm of anal verge distal to rectosigmoid junction
Left sided colitis - extending from sigmoid to splenic flexure
Right sided colitis - beyond the splenic flexure
What are the treatments for UC
5ASA
MMX
Biologics
Crohns vs UC
